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Treatment for recurrent itchy rash on arm and thigh?

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Dermatologist
Practicing since : 2006
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my 19 year old son has a itchy rash on his right hand, left arm and right thigh. He had this rash for about 5 weeks, went to the doctor three weeks ago and they did blood work, told him is was an allergic reaction to something. He took enough medicine to make the itching stop, but he says the rash never quite went away. However, it has started itching again the past two days. He says he feels fine other than and stuffy/runny nose, we have had really cold dry weather the past month. I have a photo of the rash if needed.
Posted Fri, 28 Feb 2014 in Skin Rash
 
 
Answered by Dr. Kalpana Pathak 3 hours later
Brief Answer: it could be alleegic contact dermatitis Detailed Answer: Hi, Thanks for writing to us. From the description provided and images attached I could think of two possibilities 1) Allergic contact dermatitis where there could be wide spread red itchy bumpy rash. Treatment is oral steroids, oral antihistamine and topical steroids. If rash is mild a topical steroid like betamethasone or mometasone is enough. If your son has allergic rash that has not resolved chances are either the topical steroid used is too mild or he requires oral steroids. Also if contact to allergen is there rash would persist. 2) Another possibility could be scabies. In scabies one usually has itching in night and similar history may be there in family members. Treatment would be permethrin cream application. Another possibility could be an id eruption in response to any infection or rash in other body area. Treatment would be treating the cause and applying topical steroids. I would like to know the medicines that he has used so far If anyone in family or friends has similar itching If itching is nocturnal If similar itching is there in finger webspaces, underarms or genitals Hoping to hear from you soon. Take care
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Follow-up: Treatment for recurrent itchy rash on arm and thigh? 10 minutes later
the medicines that he has used so far - cream is triamcinolone acetonide .1% and pill is hydroxyzine XXXXXXX 25mg. He took this for a few days the itching went away so he stopped, mostly because he said the medicine (pill) knocked him out. If anyone in family or friends has similar itching - no, he is away at college but no one he is around has the itching or has a rash. If itching is nocturnal - same itching at night as it is during the day. If similar itching is there in finger webspaces, underarms or genitals - webbing of fingers and genitals
 
 
Answered by Dr. Kalpana Pathak 4 hours later
Brief Answer: details below Detailed Answer: Hi, Thanks for writing back. As finger webs and genitals are involved and the rash has persisted for more than a month, I would advise that scabies should be considered as a strong possibility. Had he visited my clinic, I would have prescribed Permethrin 5 percent cream application all over the body neck downwards. This has to be applied just once overnight and the whole tube should be used at one go, so that whole body area is covered properly and then in morning a proper bath should be taken. Hydroxyzine is an effective but a sedating antihistamine. So he may use levocetrizine twice daily till itching persists. Also once permethrin has been applied, from next day onwards, he may continue using triamcinolone cream twice in a day over the itchy rashes. Hopefully in a week or two, his itching and lesions would resolve. Hope this helped. Take care
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Follow-up: Treatment for recurrent itchy rash on arm and thigh? 5 hours later
Why has no one else contracted the scabies. He was home for the holidays and no one got them, he even slept in my bed a couple of nights. I just thought they were very contagious.
 
 
Answered by Dr. Kalpana Pathak 43 hours later
Brief Answer: Scabies is contagious Detailed Answer: Hi, Thanks for writing back. Scabies spreads through close physical contact.Scabies mite can survive outside body for few hours, so sharing bedding or towel or clothes may cause it. Sometimes one may get scabies but may have no manifestations or symptoms. Also after contact usually around six weeks are required for any symptom. So in your case, either you have not contracted scabies as it requires close persistent physical contact or you might have contracted it but not showing its manifestations or may show it after 6 weeks. In my opinion, there is no harm in applying permethrin empirically. So your son may use it to see if his lesions and itching resolves. Hope this answered your query. Take care
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